Provider Demographics
NPI:1467723635
Name:POSITIVE ENERGY MEDICINE
Entity Type:Organization
Organization Name:POSITIVE ENERGY MEDICINE
Other - Org Name:ABELARD PSYCHOTHERAPY & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABELARD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS,BC
Authorized Official - Phone:617-721-1153
Mailing Address - Street 1:450 PEARL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1617
Mailing Address - Country:US
Mailing Address - Phone:781-344-0057
Mailing Address - Fax:
Practice Address - Street 1:450 PEARL ST STE 3
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1617
Practice Address - Country:US
Practice Address - Phone:781-344-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABELARD PSYCHOTHERAPY & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00025201Medicare UPIN